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Myopia Management
Overview
Myopia or nearsightedness is characterized as an individual unable to see well at distance in one or both eyes. For example, your child is in the classroom and is unable to see the letters MYOPIA MANAGEMENT on the smart board. The cause of this blurriness is that the child’s eyes are lengthening or elongating, which causes objects at a distance to become blurrier.
At first, your eye doctor may recommend eyeglasses or contact lenses to improve your vision at distance. This will solve the immediate problem of blurriness; however, a younger child can expect an increase in the prescription for subsequent years. To limit or reduce that change, eye doctors often recommend myopia management tools. Myopia management is the treatment of nearsightedness or myopia to limit or reduce the rate of change of nearsightedness or myopia in a child. Reducing the rate of change in your child’s prescription has positive impacts on eye and vision health in the long-term.
Myopia Management Tools Options
- Lifestyle
- Eyeglasses
- Mi-Sight 1 Day Contacts
- Medication
- Orthokeratology
Is Nearsightedness Getting Worse?
What does my child with myopia or nearsightedness experience (please launch the Myopia Simulator!)?
As you scroll on the myopia simulator, you will see negative values or numbers. These numbers indicate the levels of nearsightedness.
Launch Myopia Simulator
How do you correct myopia or nearsightedness?
The most common solution or correction are prescribed glasses or contact lenses; however, new research and development has created additional evidence-based treatment options to decrease the advancement of myopia or nearsightedness.
What are types of myopia management?
- Prescribed eyeglasses
- Contact Lenses (peripheral defocus contacts)
- Soft Multifocal Contact Lenses
- Soft Contact Lenses with patented technology
- Orthokeratology
- Medications (low dose atropine)
- Lifestyle Changes
What are complications of myopia as an aging adult?
- Myopic macular degeneration (MMD)
- A serious eye condition that can lead to loss of vision in one or both eyes.
- Retinal detachment
- A serious eye condition that can cause vision loss and often requires surgical intervention by a vitreo-retinal surgeon.
- Primary open-angle glaucoma
- A serious eye condition causing vision loss starting in her peripheral vision but causing central vision loss in moderate to advanced stages of the disease.
- Cataracts o An eye disease causing slow, gradual loss of vision that often requires surgical correction when indicated by your eye doctor.
MYOPIA MANAGEMENT – Lifestyle
There are many factors that cause the increase of nearsightedness, but there are lifestyle changes that can be implemented to reduce risk.
- Increase outdoor activity– natural sunlight to DECREASE risk of myopia
- Reduce screen time on devices – limit the time on electronic devices
- Hold reading material at a comfortable distance – HARMON’s distance
Speak with your eye doctor for any additional recommendations.
MYOPIA MANAGEMENT – Eyeglasses
When your eye doctor prescribes eyeglasses, it is important to wear them recommended by your eye doctor. Children that are nearsighted should wear their glasses full time. Research studies show young children wearing glasses full time show less prescription change the subsequent year compared to those who did not wear their glasses full time.
In addition, your eye doctor may recommend lined or no-line bifocals (progressives), as some studies show a decrease rate of progression of nearsightedness.
MYOPIA MANAGEMENT – Medication
Low dose atropine has been studied through several studies known as Atropine in the Treatment of Myopia (ATOM 1), Atropine in the Treatment of Myopia (ATOM 2), and Low-Concentration Atropine for Myopia (LAMP) studies. It is commonly known that topical Atropine has side effects of blurred vision at near (affecting the focusing mechanism of the eye) and increased light sensitivity (pupil dilated). While rare, systemic side effects could take place, but are extremely rare for topical (eye drop) applications.
ATOM 1 studied atropine 1% with an outcome of reducing myopia progression and axial elongation (how long the eyeball grows).
ATOM 2 studied different levels of atropine. Atropine 0.01% was determined to be the most optimal concentration with the least amount of side effects for patients in the research studies.
LAMP studied two specific concentrations of atropine between 0.01% and 0.05%. The double-blinded, randomized placebo-controlled study concluded that 0.05% was most effective concentration with the least amount of side effects.
Overall, talk with your eye doctor to determine if low dose atropine could be an option.
MYOPIA MANAGEMENT - MiSight® 1 day Contact Lenses
MiSight® 1 day contacts lenses are specifically designed daily disposable contact lenses engineered to reduce nearsightedness or myopia that has been FDA approved for children aged from 8-12.
What age and who would benefit from these contact lenses? Get Violets’s take on contact lenses!
The contact lenses are approved for children from the age of 8-12 years of age. These contact lenses are used for nearsightedness or myopia (negative refractive error).
Violets Mi-Sight Story
Are there limitations in for specific prescription?
Higher levels of nearsightedness has exclusions and different levels of astigmatism. The child must be between -0.75 and -4.00D for the spherical component of the prescription; however, the contact lenses go up to -6.00D. There are limitations for patients with astigmatism correction, but it is recommended to speak to your eye doctor.
How does MiSight®1 day contact lenses decrease the advancement of nearsightedness?
MiSight®1 day lenses have multiple treatment zones that change how the light is distributed on the back part of the eye known as the retina. Below, there are four separate zones. The treatment zone aligns focused light in FRONT of the back of the eye, which has been proven to decrease the lengthening of the back of the eye. The correction zone allows light to focus on the BACK part of the eye allowing clear, comfortable vision for the wearer.
Source: https://coopervision.com/practitioner/our-products/misight-1-day/misight-1-day
How much reduction in myopia or nearsightedness was observed in the research studies 3-year randomized clinical trial of MiSight®1 day lenses?
- Reduction of 59% on average of the spherical refractive error (or myopia)
- Reduction of 52% on average of the axial length (length of the eye)
How percentage of participants in the study for MiSight®1 day lenses changed ONE step in prescription (0.25D or less) during the course of first three years of the study?
- 41% of participants remained UNCHANGED
New MiSight®1 day contact lens wearer!
How long do I have to wear the contact lenses during the week AND day?
The study required a minimum of 6 days of wear each week and to be worn 12 hours daily.
How often do I have to see my eye doctor the first year?
The typical recommended visits are as follows:
| Visits | Expectations |
|---|---|
| Comprehensive Eye Examination | Baseline eye and vision health tests |
| Myopia Discussion (within 6 months of eye exam) | Conversation regarding options |
| Contact Lens Class (Insertion/Removal) | Approximately 1 hour - Must place and remove contact lenses in order to take contact lenses home |
| 1 Week Follow-up (10-20 minutes) | Your eye doctor will check for any eye concerns due to contact lenses. |
| 1 Month Follow-up (10-20 minutes) | Your eye doctor ensures proper fit. |
| 6 Month Follow-up (10-30 minutes) | Your eye doctor will check for any change in prescription power and will update as needed. |
How often do I have to see my eye doctor after the first year?
The typical recommended visit frequency is twice a year, but this may change based upon each patient’s unique eye and vision needs.
Are there possible complications to contact lens wear and what are some of the symptoms?
Complications can arise, but proper care and wear is important to reduce or minimize these risks. Work with your eye doctor to ensure you are taking proper care of your contact lenses.
- Complications
- Allergies
- Giant Papillary Conjunctivitis
- Corneal abrasion
- Corneal infiltrates
- Dry eyes
- Microbial keratitis (very rare)
- Symptoms
- Irritated, red eyes
- Worsening pain in or around the eyes
- Light sensitivity
- Sudden blurry vision
- Unusually watery eyes or discharge
Long-Term Outlook for MiSight®1 day Lens Wearer
What age does the child stop needing treatment?
At the present time, the research studies show that myopia continues to increase at least to age 15 in the present MiSight®1 day lens studies. Therefore, it is important to continue treatment or discuss with your eye doctor your options.
MYOPIA MANAGEMENT – Orthokeratology
Orthokeratology lenses are rigid gas permeable lenses that are placed on the front surface of the eye prior to bed time each night. The contact lens reshapes the cornea (front surface of the eye) consistent with the treatment needed to allow for clear vision during the day without wearing contact lenses. Please talk with your eye doctor to determine if this option is right for you! Check out a video by Dr. Joseph Allen or Doctor Eye Health show to learn more!
Commonly Asked Questions
How common is myopia in the general population, in the world, and how has it changed?
Approximately 20 million children in the United States have been diagnosed with myopia. By 2050, it is predicted that at least 50% of the world’s population will be myopic. In the last two generations, myopia has increased from 25% to 42%.
Is myopia genetic or what are the changes my child will be nearsighted?
Yes, genes or the genetic makeup of everyone does play a role in the presence or progression of myopia in young people. In twin studies, research shows an up to 90% link with genetics between twin siblings. If one or both parents are nearsighted, it increases the risk that your children will be as well (the risk is even greater with both parents).
Myopia management is important for the overall eye health of children. There are simple recommendations your eye doctor can provide or more sophisticated management tools (specific contacts, medications, etc.) that can be implemented to improve the health of your child’s eye and vision health. Speak with your eye doctor at your next appointment to learn more!
In the studies, what is the relative reduction of advancement of myopia over time using Atropine 0.05%?
The study shows approximately 66% reduction of myopia over time. This assumes that all instructions are being followed like the clinical trial of LAMP.
How many visits can we expect in the first year of medication therapy?
The table below gives a typical outlook for follow-ups recommended in the first year. This follow-up schedule can change depending on the needs of each child.
| Exams/Follow-Ups | Brief Overview of Visit |
|---|---|
| Comprehensive Eye Examination | - Complete eye and vision health assessment |
| Myopia Management Consult (30 min) | - Discussion on the therapy in office |
| 3 months (15-30 min) | - Check for change in vision |
| 6 months (30 min-1 hr) | - Check for change in vision - Refraction completed |
| 9 months (15-30 min) | - Check for change in vision |
| 1 year - Comprehensive Eye Examination | - Complete eye and vision health assessment |
How many visits can we expect in sequential years of medication therapy?
| Exams/Follow-Ups | Brief Overview of Visit |
|---|---|
| Comprehensive Eye Examination | - Complete eye and vision health assessment |
| 4 months | - Check for change in vision |
| 6-8 months (30 min-1 hr) | - Check for change invision - Refraction completed |
| 1 year - Comprehensive Eye Examination | - Complete eye and vision health assessment |
What are some side effects noted taking the eye drops?
- Blurry Vision at near
- Increased Light Sensitivity
- Allergic conjunctivitis or dermatitis in 16% of patients in ATOM 2 study (sensitivity to the eye causing redness or dry skin – variable based upon pharmacy chosen & preservative used)
Does medical insurance or vision plans cover this form of myopia management?
No, medical or vision plans do not cover the cost of these evaluations. As of now, medical policies do not consider refractive change a disease process.
Does medical insurance cover the low dose atropine?
No, the cost of compounded atropine 0.05% is not covered by medical insurance. The typical cost is around $75-100.00 for a three-month supply.
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